TWO SURGICAL "CLUBS" IN LONDON

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It is in this point of view that the life and work of

LmNGSTONE appeal most impressively to the outlyingworld-to that "foreign opinion" which, in the words ofMadame DE STAEL, is "that of a contemporaneous

posterity." Precisely from among those Powers, France,Germany, and now Italy, in which colonial expansion is

most valued and promoted, come the most appreciative, themost enthusiastic, eulogies of the many-sided explorer,apostle, and civiliser, seeing as they do the solid, andin the best sense remunerative, acquisitions made in

the Dark Continent on the lines and on the methods

which he laid and carried out. Of those eulogiesthat from the pen of the accomplished nature-student and

publicist, Professor ADRIANO AUGUSTO MICHIELI, repre-

senting the Italian Geographical Society, is not the least

felicitously inspired and morally glowing. Having, for

better or worse, acquired a foothold on the Red Sea littoral,in Somaliland on the Indian Ocean, and in the Tripolitaniaon the Mediterranean, Italy finds it the most urgent of

problems to recoup herself for the blood and treasure

she has lavished on their conquest, to convert them from

being a drain on her resources, and to become an outlet

for her rapidly increasing population and a treasure-houseof financial development. " Follow in the footsteps of

the British explorer, imitate, nay, if possible, improve upon,his methods, assimilate his humanitarian spirit, and so

conquering on the lines of conciliation’ make the

intruding, innovating power the nursing mother’ of

progress, prosperity, and peace "-such is the burden of

Italian, nay, of European, eulogy on DAVID LIVINGSTONE.And safely may it be said that no consummation could

have been more gratifying, more compensating to that great,simple-minded, and modest philanthropist, discoverer, andrehabilitator than the realisation that his achievement in

Equatorial Africa had become an inspiration of universalChristendom to "go and do likewise" and to be thrice-

blest in the process and its result.

Annotations.

TWO SURGICAL "CLUBS" IN LONDON.

11 Ne quid nimis."

IT is a curious fact that the hospital surgeons of Londonrarely have the opportunity of witnessing the performance ofoperations by any other surgeons than those of the hospitalto which they are themselves attached, and therefore it isnot at all improbable that many niceties of method becomeknown to only a small circle. In order to remedy this stateof affairs a surgical club" " was started among the membersof the surgical staffs of those hospitals in London to whichare attached medical schools, and arrangements were madeto invite the surgeons of these hospitals to visit in turn thedifferent institutions. A beginning was made in February,when some 30 surgeons visited St. Bartholomew’s Hospital,and saw a number of operations performed by various

Imembers of the surgical staff. Great interest was shown, and it is clear that the experiment is likely to bea success. This scheme being limited to general hospitalsand those possessing medical schools omitted several

important hospitals, and amongst these was the Royal

Free Hospital, which indeed possesses a medical school,.and therefore might reasonably have been included.At a number of the hospitals omitted from the earlier-

surgical club" " the surgical staffs have decided that the-example set them might usefully be followed, and a

second surgical "club" has been formed. Among the-

hospitals comprised in this second scheme are the

Royal Free Hospital, the Hospital for Sick Children,Great Ormond-street, the Temperance Hospital, and severalothers, and a beginning was made last week, when some-16 surgeons assembled at the Royal Free Hospital and

witnessed a number of operations performed by the surgicalstaff. The schemes have proved certainly successful in both-instances, and should result in benefit to the surgeons ofLondon.

THE CITY OF MADRAS AND ITS IMMUNITYFROM EPIDEMIC PLAGUE.

THE question has often been asked why during the past17 years, when plague has been visiting nearly the whole ofIndia, and ravaging in a disastrous manner many thickly-populated communities, the disease has never succeeded ingaining a foothold in the city of Madras with its populationof over half a million. Notwithstanding repeated importa-tions of the infection there has been no outbreak, with the-

exception of a comparatively slight epidemic in 1905-06’limited to the fishing population living on the extreme-

outskirts of the municipal boundary and therefore hardlyto be regarded as being within the city itself. Madras is thethird city in India in point of population, and as a seaport.ranks fifth in importance, having a large trade by shipping-with eastern ports, and particularly with Rangoon, where-

plague is often epidemic, and from which large quantities of-rice or other grain are brought, such cargoes attracting ratson board ship at the place of loading. On the landward

side Madras is in close communication by rail with otherparts of India in which plague is now annually epidemic,including Mysore, and especially the town of Bangalore inthat State, where the disease has of late years been very-prevalent. But in spite of these and other opportunities forcontracting the infection Madras has, with the slightexception mentioned above, remained free from epidemic-plague during the past 17 years, and only sporadic cases,spread over that period and resulting in a total of 125

deaths, have been recorded in the city. Yet Bombay and’Calcutta have suffered severely year after year, the former,with a population of 979,445, having had no fewer than178,440 plague deaths, and the latter, with 1,222,313-inhabitants, having had over 61,000 in the period in

question. With the purpose of discovering, if possible, the-reasons for this apparent immunity of the city of Madras,from plague epidemics, the Advisory Committee, appointedjointly by the Secretary of State for India, the RoyalSociety, and the Lister Institute, some little time ago-ordered an inquiry to be made by its expert officers into.

the matter, and the results of this have recently beenpublished in the " Seventh Report on Plague Investigations-in India." 1 This report states that the conditions of houseconstruction in the city of Madras are not unfavourable to.the establishment of epidemic plague, and that suitable

climatic conditions for this prevail during the winter months.Though neither rats nor rat-fleas are so plentiful as in other-places which have been examined by the committee’s experts,still there are probably enough of both to maintain plague ifit were introduced. Moreover, the local rats (Mus rattus).have been shown by experiment to be exceptionally suscep-tible to plague infection. It therefore appears that the city

1 Vide the Journal of Hygiene, Plague Supplement II. TheCambridge University Press. Jan. 13th, 1913. Price 7s. net.